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Horng-Chyuan Lin,1– 3 Meng-heng Hsieh,1,2 Yu-Lun Lo,1,2 Hung-Yu Huang,1,2 Shih-Wei Huang,1,2 Chien-Da Huang,1,2 Po-Jui Chang,1,2 Chun-Yu Lo,1,2 Ting-Yu Lin,1,2 Yueh-Fu Fang,1,2 Shu-Min Lin,1,2 Chun-Yu Lin,1,2,* Ying-Huang Tsai1,2,4,* 1Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 4Department of Pulmonary and Critical Care Medicine, Xiamen Chang Gung Hospital, Xiamen, 361028, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chun-Yu Lin, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kweishan, Taoyuan, 33305, Taiwan, Tel +886-3-3281200 ext. 8467, Fax +886-3-3282474, Email pitiful1984@gmail.com Ying-Huang Tsai, Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation and Department of Respiratory Therapy, College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kweishan, Taoyuan, 33305, Taiwan, Tel +886-3-3281200 ext. 8470, Fax +886-3-3282474, Email chestmed@cgmh.org.twBackground: Non-cystic fibrosis bronchiectasis is associated with airway pathogen colonization. We planned to investigate the inflammatory markers in patients with different airway pathogens and their correlation with disease severity.Methods: We enrolled patients aged between 20 and 75 from October 2021 to August 2022. All patients had sputum evaluation for bacterial and fungal cultures before enrollment, and were classified into four groups according to the culture results.Results: Forty-four patients with non-CF bronchiectasis and six controls were enrolled and categorized as follows: Group 1, no pathogens identified in sputum cultures (n = 14); Group 2, positive fungal culture results (n = 18); Group 3, positive P. aeruginosa culture results (n = 7); and Group 4, positive culture results for both fungi and P. aeruginosa (n = 5). Group 4 had significantly higher serum defensin α 1, IL-6 and tissue inhibitors of MMP (TIMP)-1 levels than group 1 patients. The serum levels of IL-6 and TIMP-1 were positively correlated with the FACED score and negatively correlated with distance-saturation product.Conclusion: Significantly higher levels of serum IL-6 and TIMP-1 were found in the patients who had concomitant fungal and P. aeruginosa colonization, and were closely related to clinical severity and may have important roles in disease monitoring.Keywords: TIMP-1, non-cystic fibrosis bronchiectasis, clinical severity

Ting-Yu Lin,1,2 Firdian Makrufardi,3,4 Nguyen Thanh Tung,3,5 Amja Manullang,3 Po-Jui Chang,1,2 Chun-Yu Lo,1,2 Tzu-Hsuan Chiu,1 Pi-Hung Tung,1 Chiung-Hung Lin,1 Horng-Chyuan Lin,1,2 Chun-Hua Wang,1,2 Shu-Min Lin1,2 1Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 4Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia; 5Otorhinolaryngology Department, Cho Ray Hospital, Ho Chi Minh City, VietnamCorrespondence: Shu-Min Lin, Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N. Road, Taipei, Taiwan, Fax +886 33272474, Email smlin100@gmail.comBackground: Early-onset asthma (EOA) and late-onset asthma (LOA) are two distinct phenotypes. Air pollution has been associated with an increase in poorer asthma outcomes. The objective of this study was to examine the effects of traffic-related air pollution (TRAP) on asthma outcomes in EOA and LOA patients.Methods: A cross-sectional study was conducted on 675 asthma patients (LOA: 415) recruited from a major medical center in Taiwan. The land-use regression (LUR) model was used to estimate the level of exposure to PM10, PM2.5, NO2, and O3 on an individual level. We investigated the association between TRAP and asthma outcomes in EOA and LOA patients, stratified by allergic sensitization status, using a regression approach.Results: An increase in PM10 was associated with younger age of onset, increased asthma duration, and decreased lung function in EOA patients (p< 0.05). An increase in PM10 was associated with older age of onset, and decreased asthma duration, eosinophil count, and Asthma Control Test (ACT) score in LOA patients. An increase in PM2.5 was associated with younger age of onset, increased asthma duration, decreased eosinophil count, and lung function in EOA patients (p< 0.05). An increase in PM2.5 was associated with decreased lung function and ACT score in LOA patients. An increase in NO2 was associated with increased eosinophil count and decreased lung function in EOA patients (p< 0.05). An increase in O3 was associated with decreased lung function in LOA patients (p< 0.05). In addition, associations of TRAP with age of onset and eosinophil counts were mainly observed in both EOA and LOA patients with allergic sensitization, and an association with ACT was mainly observed in LOA patients without allergic sensitization.Conclusion: The impact of TRAP on age of onset, eosinophil count, and lung function in EOA patients, and ACT in LOA patients, was affected by the status of allergic sensitization.Keywords: air pollution, allergy, early-onset asthma, late-onset asthma, respiratory disease

Pei-Wen Lin,1– 3 Hsin-Ching Lin,2– 6 Chun-Tuan Chang,4 Meng-Chih Lin,2,3,7 Michael Friedman,8,9 Anna M Salapatas9 1Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Institute of Healthcare Management, Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan; 5Institute of Biomedical Science, National Sun Yat-sen University, Kaohsiung, Taiwan; 6Department of Otolaryngology, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 8Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; 9Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USACorrespondence: Hsin-Ching Lin, Tel +886-7-7317123 ext.2533, Fax +886-7-7313855, Email hclin@adm.cgmh.org.tw; enthclin@aol.comPurpose: To compare peripapillary and macular vascular densities (PVDs and MVDs) between patients with obstructive sleep apnea/hypopnea syndrome (OSA) and control subjects with symptoms of sleep-related breathing disorders only by swept-source optical coherence tomography angiography (OCTA).Participants and Methods: In this prospective study, 192 participants underwent a full-night polysomnography to determine OSA severity and subsequently received OCTA measurements as well as AngioTool software analysis.Results: A total of 146 patients with OSA (51 mild, 43 moderate, 52 severe) and 24 control subjects (apnea/hypopnea index, AHI < 5) were enrolled. PVDs and MVDs in the superficial and choroidal layers were significantly different among the four groups. When participants with simple snoring/mild OSA (AHI < 15) were grouped together and compared with moderate/severe OSA (AHI ≥ 15), PVDs were significantly lower for the latter group in the superficial layer (p = 0.0003), deep layer (p = 0.004), and choroidal layer (p = 0.003). MVDs were also lower for the moderate/severe OSA group in the superficial (p = 0.012) and choroidal layer (p = 0.004). Negative correlations were identified between AHI and PVDs in the superficial layer (ρ = − 0.257, p = 0.0007), deep layer (ρ = − 0.197, p = 0.0102) and choroidal layer (ρ = − 0.220, p = 0.0039) and between AHI and MVDs in the superficial layer (ρ = − 0.199, p = 0.0094) and choroid layer (ρ = − 0.186, p = 0.0152).Conclusion: PVDs and MVDs were significantly lower in patients with moderate/severe OSA as compared to subjects with simple snoring/mild OSA. Furthermore, decreased PVDs and MVDs significantly correlated with OSA severity.Keywords: peripapillary vascular density, macular vascular density, peripapillary retinal nerve fiber layer, swept-source optical coherence tomography angiography, snoring, obstructive sleep apnea/hypopnea syndrome

Yao-Chi Chuang,1,2 Pei-Wen Lin,2– 4 Hsin-Ching Lin,2,4– 6 Chun-Tuan Chang,6 Michael Friedman,7,8 Anna M Salapatas,8 Chih-Yun Lin9 1Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 4Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 5Department of Otolaryngology, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Business Management, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan; 7Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; 8Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; 9Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanCorrespondence: Hsin-Ching Lin, Department of Otolaryngology, Sleep and Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext.2533, Fax +886-7-7313855, Email hclin@adm.cgmh.org.tw; enthclin@aol.comObjective: To determine the presence of lower urinary tract symptoms (LUTS), and overactive bladder (OAB) symptoms in men with obstructive sleep apnea/hypopnea syndrome (OSA) and the effects of transoral robotic surgery (TORS) for the treatment of OSA on these conditions.Materials and Methods: One hundred twenty-three patients with a diagnosis of OSA were prospectively enrolled. The evaluations of LUTS and OAB symptoms were based on self-administered questionnaires containing international prostate symptom score (IPSS) and OAB symptom score (OABSS), respectively. Men with an OABSS urgency score of ≥ 2 and sum score of ≥ 3 were considered to have OAB. The therapeutic outcomes were assessed at baseline, and 12 weeks after TORS-OSA Surgery.Results: There were significant differences in IPSS, and OABSS according to OSA severity. After TORS-OSA surgery, significant improvements on OSA severity, daytime quality of life (QoL) and nighttime sleep quality were observed. TORS-OSA surgery was also associated with a statistically significant improvement of LUTS, LUTS QoL score, and OAB symptoms (IPSS 22.1% decrease; IPSS QoL score 21.1% decrease; OABSS17.4% decrease) at post-operative 3 months’ follow-up. The presence of OAB, and severe nocturia was significantly reduced from 22.8% to 11.4% (p=0.001), 5.7% to 0.8% (p=0.031) after TORS-OSA surgery. There were no patients who had acute airway compromise or massive bleeding peri- or post-operatively.Conclusion: TORS upper airway surgery could improve LUTS and OAB symptoms on male patients with OSA in addition to improvement of major parameters of sleep study and sleep-related QoL.Keywords: snoring, obstructive sleep apnea, lower urinary tract symptoms, overactive bladder symptoms, OSA surgery, transoral robotic surgery

Pei-Wen Lin,1,2 Hsin-Ching Lin,2– 5 Chun-Tuan Chang,5 Michael Friedman,6,7 Anna M Salapatas,7 Meng-Chih Lin,2,8 Chih-Yun Lin9 1Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan; 2Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; 3Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan; 4Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; 5Department of Business Management, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung City, Taiwan; 6Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago City, IL, USA; 7Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago City, IL, USA; 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan; 9Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, TaiwanCorrespondence: Hsin-Ching Lin, Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext.2533, Fax +886-7-7313855, Email hclin@adm.cgmh.org.tw; enthclin@aol.comPurpose: Obstructive sleep apnea/hypopnea syndrome (OSA) results in repeated oxygen desaturation, repeated arousals, and episodic nocturnal activation of sympathetic nervous system during sleep. Untreated OSA is strongly associated with an increase of cardio- and cerebrovascular disorders, as well as the damages of ophthalmological microstructures. However, previous literature only simply studied the association between the ophthalmic disorders and OSA. In the present study, we first investigated the alterations of ocular surface and tear film non-invasively with the innovated corneal topographer in untreated OSA patients and normal control subjects. Furthermore, we analyzed in depth whether the correlations between OSA severity and ocular surface exams exist.Participants and Methods: Participants underwent a full-night polysomnography to determine OSA occurrence and severity. All participants subsequently received Ocular Surface Disease Index questionnaire and comprehensive ocular exams, including floppy eyelid syndrome (FES) assessment, oculus scan for tear meniscus height, non-invasive keratograph tear film breakup time (NIKBUT), and ocular surface redness, endothelial cell density, and corneal fluorescein staining.Results: One hundred eighty-one participants were prospectively enrolled in the study. FES was found in 11.5% of the normal control group and 60.0% of the severe OSA group (p=0.0005). There were significant differences in the first-NIKBUT (F-NIKBUT) (p < 0.0001), average-NIKBUT (A-NIKBUT) (p = 0.0007), and redness scores over the nasal bulbar (p = 0.032), temporal bulbar (p < 0.0001), nasal limbal (p = 0.014), and temporal limbal (p < 0.0001) areas among the four groups. F-NIKBUT and A-NIKBUT were significantly shorter in the moderate/severe OSA group (apnea/hypopnea index (AHI) ≥ 15) than in the normal/mild OSA group (AHI < 15) (both p < 0.0001). The redness scores over the temporal bulbar (p < 0.0001) and temporal limbal (p < 0.0001) areas were also significantly different in these two OSA groups. Moreover, F-NIKBUT and A-NIKBUT negatively correlated with AHI. Nasal bulbar redness, temporal bulbar redness, nasal limbal redness, and temporal limbal redness positively correlated with AHI.Conclusion: OSA patients had higher occurrence of FES. The NIKBUT was significantly shorter, and the temporal conjunctival redness scores over bulbar and limbal areas were higher in the moderate/severe OSA group than in the normal/mild OSA group. NIKBUT and conjunctival hyperemia significantly correlated with the severity of untreated OSA.Keywords: snoring, obstructive sleep apnea, ocular surface and tear film

Ching-Huang Lin,1 Hsien-Chang Lin,2 Chien-Yu Chen,3 Chong-Chung Lih4 1Department of Electronic Engineering, National Yunlin University of Science & Technology, Yunlin, 640, Taiwan; 2Graduate School of Engineering Science and Technology, National Yunlin University of Science & Technology, Yunlin, 640, Taiwan; 3Graduate Institute of Color and Illumination Technology, National Taiwan University of Science and Technology, Taipei, 106, Taiwan; 4Department of Optometry, Central Taiwan University of Science and Technology, Taichung, 406, TaiwanCorrespondence: Chong-Chung LihDepartment of Optometry, Central Taiwan University of Science and Technology, Taichung, 406, TaiwanTel +866 4 22391647 6981Email cclih@phys.nthu.edu.twPurpose: This study used low-level laser irradiation on auricular points for the eyes of junior college teenagers with myopia to observe the changes in refractive errors and eye accommodation. According to the Sterner’s study, we used the relationship between the amplitude and subjective symptoms to assess the degree of improvement in visual fatigue caused by changes in accommodation.Methods: Participants were 49 healthy junior college teenagers, with an average age of 16.04± 0.80 years old, and the refractive errors of both eyes were between − 1.50 D and − 5.00 D. All participants underwent refractive error tests before and after class and after a 30-min break. In a 30-min break, all participants underwent two tests of with (experimental group) and without (control group) low-level laser irradiation on the auricular points. Then, refractive error tests were conducted to evaluate the participants’ eye accommodation.Results: The results revealed that with treatment of the auricular points with and without low-level laser irradiation, the refractive error of the participants’ binocular left and right eyes decreased by − 0.12 D (− 0.18 D) in the experimental grou and by − 0.05 D (− 0.02D) in the control group. For the amplitudes of accommodation (AA) examination, the AA of the participants’ binocular in the experimental group became 7.98 ± 1.35 D (7.65 ± 1.37 D). The AA of participants’ binocular can recover to the level before the class.Conclusion: The results indicated that low-level laser irradiation at auricular points restored the eye accommodation faster than did natural closing of the eyes.Keywords: low-level laser irradiation, myopia, teenager, accommodation, auricular point

Hsien-Cheng Lin,1 Chia-Chen Chen2 1Business College, Taizhou University, Taizhou, Zhejiang Province, People’s Republic of China; 2Department of Anesthesiology, China Medical University Hsinchu Hospital, Zhubei, Taiwan, Republic of ChinaCorrespondence: Hsien-Cheng LinBusiness College, Taizhou University, No. 1139, Shifu Avenue, Taizhou, Zhejiang Province, People’s Republic of ChinaEmail linxianzheng0711@tzc.edu.cnChia-Chen ChenDepartment of Anesthesiology, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong Road, Zhubei, Hsinchu Country, 302, Taiwan, Republic of ChinaEmail d7635@mail.cmuhch.org.twObjective: The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors.Methods: This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data.Results: The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p< 0.001), but perceived efficacy did not (β=− 0.019, t=− 0.619, p> 0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p< 0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, − 0.472; t=26.303, − 17.694; p< 0.001, p< 0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors.Conclusion: When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).Keywords: COVID-19, extended parallel process model, perceived threat, perceived efficacy, prevention behavior

Chiung-Hsin Chang, 1 Horng-Chyuan Lin, 1, 2 Chia-Hung Yang, 3 Shu-Ting Gan, 4 Chi-Hsien Huang, 1 Fu-Tsai Chung, 1, 2, 5 Han-Chung Hu, 1, 2 Shu-Min Lin, 1, 2 Chih-Hao Chang 1, 2, 5 1Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2Chang Gung University, College of Medicine, Taoyuan, Taiwan; 3Division of Cardiology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; 4Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, TaiwanCorrespondence: Chih-Hao Chang Department of Thoracic MedicineChang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanEmail ma7384@cgmh.org.twPurpose: The 6-min walk test (6MWT) is a useful tool to assess the physiologic function in patients with chronic obstructive pulmonary disease (COPD). The recent study showed that patients with COPD with oxygen desaturation during the 6MWT had an increased risk of exacerbation and death compared with those without oxygen desaturation. This study aimed to explore the potential risk factors for exercise-induced desaturation (EID) in patients with COPD.Patients and Methods: Adult patients with COPD were enrolled from the Chang Gung Research Database between January 2013 and January 2017. Age, sex, body mass index, underlying diseases, medications, and results of the pulmonary function tests and 6MWT were retrospectively collected and analyzed.Results: Among 1768 patients with COPD, 932 (52.7%) had oxygen desaturation, and the other 836 (47.3%) had no desaturation during the 6MWT. The patients with EID had a shorter 6-min walk distance than those without desaturation (352.08± 120.29 vs 426.56± 112.56, p< 0.0001). In the multivariate logistic regression analysis, older age, female sex, lower forced expiratory volume in 1 s, and comorbidity with atrial fibrillation (AF) were associated with oxygen desaturation during the 6MWT. Patients with EID had higher exacerbation frequency than those without desaturation in the 1-year follow-up period (0.59± 1.50 vs 0.34± 1.26, p< 0.0001). Patients with COPD with AF also had a higher rate of exacerbation requiring emergency department visit or hospitalization in the 1-year follow-up.Conclusion: This study demonstrates that older age, low FEV1, and female sex are risk factors for EID. Desaturation during 6MWT is related to frequent acute exacerbation of COPD in the 1-year follow-up.Keywords: 6-minute walk test, A-fib, exacerbation, hypoxia

Yi-Fen Lei,1,2 Hsiu-Chen Lin,3,4 Hsiu-Li Lin,5 Yow-Sheng Uang,2 Hui-Wen Cheng,2 Li-Hsuan Wang2,6 1Department of Pharmacy, Mackay Memorial Hospital, Taipei 10449, Taiwan; 2School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan; 3Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; 4Department of Clinical Pathology, Taipei Medical University Hospital, Taipei 11031, Taiwan; 5Department of Neurology, General Cathay Hospital, New Taipei City 22174, Taiwan; 6Department of Pharmacy, Taipei Medical University Hospital, Taipei 11031, TaiwanCorrespondence: Li-Hsuan WangSchool of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing St., Taipei 11031, TaiwanEmail shiuan@tmu.edu.twObjective: The effect of statins and fibrates on the risk of chronic obstructive pulmonary disease (COPD) remains unclear. The aim of this study was to investigate the effects of statins and fibrates on the risk of COPD in patients with hyperlipidemia.Patients and Methods: This study involved a retrospective cohort with a follow-up period of 6 years. We identified patients who were diagnosed as having hyperlipidemia between 2000 and 2016 from Taiwan’s National Health Insurance Research Database. A Cox proportional hazard model was used to estimate the risk of COPD among different groups. The dose-related effects of statins and fibrates on the risk of COPD were evaluated according to the defined daily dose (DDD).Results: Patients with hyperlipidemia not using statins and fibrates (group II) had a significantly higher risk of COPD compared with their comparison group, with an adjusted hazard ratio (HR) of 1.091 [95% confidence interval (CI): 1.034– 1.152, p < 0.01]. Dose-dependent reduction in the risk of COPD was observed in patients with hyperlipidemia using statins or fibrates compared with patients not using them. Moreover, with an increase in cumulative exposure, a reduced risk of COPD was observed in patients using more than 361 DDDs, with an adjusted HR of 0.474 (95% CI: 0.401– 0.559, p < 0.001). Patients on fibrate monotherapy using more than 541 DDDs were observed to have an adjusted HR of 0.454 (95% CI: 0.226– 0.910, p < 0.05) and those on statin monotherapy with over 361 DDDs were noted to have an adjusted HR of 0.583 (95% CI: 0.459– 0.740, p < 0.001).Conclusion: This study demonstrated that an increase in the cumulative exposure of statins and fibrates significantly reduced the risk of COPD in patients with hyperlipidemia, and the risk reduction appeared to be significantly dose dependent.Keywords: hyperlipidemia, statin, fibrates, chronic obstructive pulmonary disease, cohort study

Yi-Jun Lin,1 Hsing-Chieh Lin,2 Ying-Fei Yang,2 Chi-Yun Chen,2 Min-Pei Ling,3 Szu-Chieh Chen,4,5 Wei-Yu Chen,6,7 Shu-Han You,8 Tien-Hsuan Lu,2 Chung-Min Liao2 1Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei, Taiwan; 2Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan; 3Department of Food Science, National Taiwan Ocean University, Keelung City, Taiwan; 4Department of Public Health, Chung Shan Medical University, Taichung, Taiwan; 5Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 6Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan; 7Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 8Institute of Food Safety and Risk Management, National Taiwan Ocean University, Keelung City, TaiwanCorrespondence: Chung-Min LiaoDepartment of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan, ROCTel +886 2 3366 3475Email cmliao@ntu.edu.twBackground: Broad-scale evidence has shown the significant association between ambient air pollutants and the development of tuberculosis (TB). However, the impact of air quality on the risk of TB in Taiwan is still poorly understood.Objective: To develop a probabilistic integrated population-level risk assessment approach for evaluating the contribution of ambient air pollution exposure to the risk of TB development among different regions of Taiwan.Materials and methods: A Bayesian-based probabilistic risk assessment model was implemented to link exposure concentrations of various air pollutants quantified in a probabilistic manner with the population-based exposure-response models developed by using an epidemiological investigation.Results: The increment of the risk of TB occurred in a region with a higher level of air pollution, indicating a strong relationship between ambient air pollution exposures and TB incidences. Carbon monoxide (CO) exposure showed the highest population attributable fraction (PAF), followed by nitrogen oxides (NOX) and nitrogen dioxide (NO2) exposures. In a region with higher ambient air pollution, it is most likely (80% risk probability) that the contributions of CO exposure to development of TB were 1.6–12.2% (range of median PAFs), whereas NOX and NO2 exposures contributed 1.2–9.8% to developing TB.Conclusion: Our findings provide strong empirical support for the hypothesis and observations from the literature that poor air quality is highly likely to link aetiologically to the risk of TB. Therefore, substantial reductions in CO, NOX, and NO2 exposures are predicted to have health benefits to susceptible and latently infected individuals that provide complementary mitigation efforts in reducing the burden of TB. Considering that people continue to be exposed to both TB bacilli and ambient air pollutants, our approach can be applied for different countries/regions to identify which air pollutants contribute to a higher risk of TB in order to develop potential mitigation programs.Keywords: tuberculosis, ambient air pollution, exposure-response function, probabilistic risk assessment, population attributable fraction

Ching-Hsiung Liu,1,2 Yen-Ying Kung,2–4 Chun-Liang Lin,1 Jen-Lin Yang,2–4 Ta-Peng Wu,3 Hong-Chun Lin,3 Yang-Kai Chang,3 Ching-Mao Chang,2–4 Fang-Pey Chen2,3 1Department of Neurology, Lotung Poh-Ai Hospital, Ilan, Taiwan, Republic of China; 2Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; 3Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; 4Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of ChinaCorrespondence: Fang-Pey ChenInstitute of Traditional Medicine, School of Medicine, National Yang-Ming University, and Director, Center for Traditional Medicine, Taipei Veterans General Hospital, Number 155, Section 2, Linong Street, Taipei 112, Taiwan, Republic of ChinaTel +8862-2875-7454Fax +8862-2875-7452Email fpchen@vghtpe.gov.twPurpose: To investigate the required sample size for and feasibility of a full-scale randomized controlled trial examining the impact of the “dose” effect of acupuncture in treating sciatica.Patients and methods: Fifty-seven patients with sciatica, aged 35–70 years, were recruited and screened. Thirty-one participants were randomly assigned to receive “low-dose” manual acupuncture (MAL) (n= 15) or “high-dose” manual acupuncture (MAH) (n=16). The acupuncture treatment was administered twice weekly for 4 weeks. The primary outcome was the visual analog scale (VAS) score at baseline and after 4 weeks of acupuncture treatment. Secondary outcomes included the Roland Disability Questionnaire for Sciatica (RDQS), the Sciatica Bothersomeness Index (SBI), and the World Health Organization Quality of Life in the Brief Edition (WHOQOL-BREF) scores at baseline and after 4 weeks of acupuncture treatment.Results: Thirty patients completed the study. For all patients, acupuncture achieved significant improvement in the VAS (5.48±2.0, p

Chien-Tzu Lee,1 Ping-Lun Hsieh,1,2 Meng-Yueh Chien,1 Jung-Yien Chien,3 Huey-Dong Wu,4 Jia-Shin Lin,1 Hsiao-Chen Lin,1 Pei-Yu Yang,2 Li-Ying Wang1,21School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 2Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; 4Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, TaiwanBackground: Pulmonary rehabilitation (PR) is now considered fundamental when managing patients with chronic respiratory disease. The individual variation in functional exercise capacity (FEC) response to PR within the cohort is unknown. The purpose of this study was to identify FEC patterns in response to PR in patients with chronic respiratory disease using the trajectory modeling method.Methods: The data of 67 patients with the chronic respiratory disease were retrospectively reviewed and analyzed in this study. All patients received once-weekly supervised training for 8 weeks. Six-minute walk distance (6MWD) was used to measure FEC. Muscle strength and 6MWD were assessed at baseline, Week 4, Week 8 and monthly for two months after PR completion. Group-based trajectory modeling (GBTM) was used to identify patterns in 6MWD in response to PR. The generalized estimating equation method was then used to detect the differences within and between the trajectories of identified groups across time.Results: Patients were grouped into low- (n=13), moderate- (n=34) and high- (n=20) FEC group based on GBTM analysis. All groups demonstrated significant improvements in 6MWD and leg muscle strength after 8-week PR. Compared to the high-FEC group, a greater proportion of the patients in the low-FEC group required oxygen supplementation during training and had worse baseline leg muscle strength.Conclusions: Patients showed distinct patterns of 6MWD changes in response to 8-week PR. Distinct characteristics for the low-FEC group included poor lower extremity strength and a greater proportion of required oxygen use at home and during training.Keywords: chronic respiratory disease, exercise training, functional exercise capacity, trajectory

Meng-Heng Hsieh,1,2,* Chun-Yu Lin,1–3,* Chen-Yu Wang,2 Yueh-Fu Fang,1–3 Yu-Lun Lo,1,2 Shu-Min Lin,1,2 Horng-Chyuan Lin1,2 1Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Pulmonary and Critical Care, Saint Paul’s Hospital, Taoyuan, Taiwan *These authors contributed equally to this work Purpose: Pseudomonas aeruginosa is associated with pulmonary function decline and high disease severity in non-cystic fibrosis (CF) bronchiectasis. The prevalence of nontuberculous mycobacteria (NTM) in non-CF bronchiectasis patients has increased recently. This study investigated the impact of NTM with or without P. aeruginosa isolates in non-CF bronchiectasis patients.Patients and methods: Our retrospective study included 96 non-CF bronchiectasis patients from January 2005 to December 2014. We recorded the presentation, exacerbations, emergency department (ED) visits, hospitalization, serial pulmonary function, radiologic studies, and sputum culture results. All patients were followed up for at least 2 years.Results: The 96 patients were divided into four groups: patients with concomitant negative NTM and P. aeruginosa isolates (n=41; group 1), patients with positive NTM isolates (n=20; group 2), patients with positive P. aeruginosa isolates (n=20; group 3), and patients with concomitant positive NTM and P. aeruginosa isolates (n=15; group 4). Compared with group 1 patients, patients in groups 2 and 3 showed a significant decline in forced expiratory volume in 1 second (FEV1). They also had more frequent annual acute exacerbations (AE), ED visits, and hospitalization. Group 4 patients had the greatest FEV1 and forced vital capacity (FVC) decline and the most frequent AE, ED visits, and hospitalization.Conclusion: Concomitant NTM and P. aeruginosa isolates in non-CF bronchiectasis are associated with the greatest pulmonary function decline and the worst disease severity. This result suggested that early recognition and prompt treatment of concomitant NTM and P. aeruginosa isolates may improve the outcome in non-CF bronchiectasis patients. Keywords: nontuberculous mycobacteria, Pseudomonas aeruginosa, non-cystic fibrosis bronchiectasis

Timothy D Becker,1 Henry C Lin,2 Victoria A Miller3 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 3Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Background: Child participation in pediatric medical visits is low. In this pilot study, we sought to better understand relationships between observed communication and child-reported perceptions of communication in a clinical setting. Materials and methods: For this cross-sectional observational study, pediatric gastroenterology appointments (n=39) were videotaped and coded to quantify various adult affective (eg, chit-chat, empathy) and facilitative (eg, asking questions, encouraging responses) behaviors toward the child, interference with child participation (eg, interrupting or ignoring child), and child verbal participation. Post-visit surveys assessed child perceptions of having voice in the clinical encounter, ease of understanding, and satisfaction with communication. Results: Parent and provider chit-chat was associated with child-reported ease of understanding. Provider facilitation was positively associated with child participation, but affective communication strategies were not. Physician interference was negatively associated with ease of understanding but positively associated with perception of voice. Conclusion: Facilitative communication may improve outcomes by enhancing child participation and thus exchange of medical information, whereas chit-chat appears to positively impact children’s perceptions of communication. Keywords: physician–patient communication, partnership, child participation, pediatric patient experience, child satisfaction

Chien-Chuan Wang,1,2 Huang-Chi Lin,2,3 Mu-Hong Chen,4,5 Nai-Ying Ko,6,7 Yu-Ping Chang,8 I-Mei Lin,9 Cheng-Fang Yen2,3 1Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Department of Psychiatry, Graduate Institute of Medicine and Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Division of Child and Adolescent Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; 5Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; 6Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Nursing Department and Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; 8School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA; 9Department of Psychology, College of Humanities and Social Science, Kaohsiung Medical University, Kaohsiung, Taiwan Objective: This study examined the differences in the current levels of depression, anxiety, and physical pain in emerging adulthood among gay and bisexual men with various experiences of traditional and cyber homophobic bullying based on gender role nonconformity and sexual orientation and the moderating effects of family and peer support.Methods: A total of 500 gay or bisexual men (age 20–25 years) in Taiwan were recruited from August 2015 to July 2017. The levels of depression, anxiety, and physical pain among gay or bisexual men who had experienced both traditional and cyber homophobic bullying (n=109), only traditional or cyber bullying (n=173), and neither traditional nor cyber bullying during childhood (n=218) were compared. The moderating effects of family and peer support on the effects of homophobic bullying victimization on depression, anxiety, and physical pain were also examined.Results: Victims of any type of homophobic bullying in childhood had more severe depression, anxiety, and physical pain in emerging adulthood than nonvictims. Victims of both traditional and cyber homophobic bullying had more severe anxiety in adulthood than victims of only traditional or cyber homophobic bullying. Family but not peer support in childhood moderated the effects of homophobic bullying victimization on current levels of anxiety and physical pain in emerging adulthood among gay and bisexual men.Conclusion: The results of the present study support that early prevention and intervention for homophobic bullying and enhancement of family support are essential to reduce mental health problems in emergent adults among gay and bisexual men. Keywords: sexual minority, homophobia, harassment, gender role nonconformity, sexual orientation

Yi-Ping Fang,1,2 Chih-Hung Chuang,3 Yi-Jhun Wu,1 Hsin-Che Lin,1 Yun-Chi Lu4 1School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, 2Department of Medical Research, Kaohsiung Medical University Hospital, 3Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, 4Graduate Institute of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Background: SN38 (7-ethyl-10-hydroxycamptothecin) is a camptothecin derivative acts against various tumors. However, SN38 is hydrolyzed in the physiological environment (pH 7.4), and this instability interferes with its potential therapeutic effect. Our objective was to investigate SN38-loaded liposomes to overcome the poor solubility of SN38 and its biodistribution, which further diminish its toxicity.Materials and methods: The sub-100 nm targeted liposomes was employed to deliver SN-38 and evaluate the characterization, release behaviors, cytotoxicity, in vivo pharmacokinetics and biochemical assay.Results: The SN38-loaded targeted liposomes consisted of small (100.49 nm) spherical nanoparticles with negative charge (-37.93 mV) and high entrapment efficiency (92.47%). The release behavior of the SN38-loaded targeted liposomes was fitted with Higuchi kinetics (R2=0.9860). Free SN38 presented initial burst release. The IC50 for the SN38-loaded targeted liposomes (0.11 µM) was significantly lower than for the SN38 solution (0.37 µM) in the MCF7 cell line (P

Tsai-Yu Wang,1 Yu-Lun Lo,1,2 Pai-Chien Chou,1 Fu-Tsai Chung,1 Shu-Min Lin,1 Ting-Yu Lin,1 Horng-Chyuan Lin,1 Chun-Hua Wang,1 Chih-Teng Yu,1 Han-Pin Kuo1 1Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; 2Healthcare Center, Chang Gung Memorial Hospital, Taipei, Taiwan Background: Osteoporosis is an important issue for patients with chronic obstructive pulmonary disease (COPD). Worse systemic inflammation and reduced exercise capacity have been reported in COPD patients with obstructive sleep apnea (OSA), implying that OSA may be an independent factor for osteoporosis in COPD patients. Methods: A total of 66 patients with bone mineral density (BMD) and polysomnography results from a previous COPD cohort (January 2008 to January 2013) were retrospectively enrolled. Clinical characteristics such as medication, pulmonary function, BMD, and results of polysomnography were analyzed. Results: The BMD in those with OSA was significantly lower than in those without OSA (-1.99±1.63 versus -1.27±1.14, P=0.045). In univariate analysis, body mass index, forced expiratory volume in 1 second, percentage of predicted value, incremental shuttle walk test, apnea–hypopnea index, and oxygen desaturation index (ODI) were significantly associated with BMD. After multivariate linear regression analysis, the ODI was still an independent factor for BMD. In addition, smaller total lung capacity is significantly associated with higher ODI and lower BMD, which implies that lower BMD might cause severer OSA via decreased total lung capacity. Conclusion: OSA may be an independent factor for BMD in patients with COPD, which implies a possible vicious cycle takes place in these patients. Keywords: chronic obstructive pulmonary disease, osteoporosis, total lung capacity

Li-Chun Hsieh,1,2 Hung-Ching Lin,2,3 Guo-She Lee4,5 1Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 2Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan; 3Department of Audiology and Speech Language Pathology, Mackay Memorial Medical College, Taipei, Taiwan; 4Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 5Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan Background: Imbalance from degeneration of vestibular end organs is a common problem in the elderly. However, the decline of vestibular function with aging was revealed in few vestibular function tests such as vestibular autorotation test (VAT). In the current VAT, there are drawbacks of poor test–retest reliability, slippage of the sensor at high-speed rotations, and limited data about the effect of aging. We developed a correlational-VAT (cVAT) system that included a small, light sensor (less than 20 g) with wireless data transmission technique to evaluate the aging of vestibular function. Material and methods: We enrolled 53 healthy participants aged between 25 and 75 years and divided them into five age groups. The test conditions were vertical and horizontal head autorotations of frequencies from 0 to 3 Hz with closed eyes or open eyes. The cross-correlation coefficient (CCC) between eye velocity and head velocity was obtained for the head autorotations between 1 Hz and 3 Hz. The mean of the CCCs was used to represent the vestibular function. Results: Age was significantly and negatively correlated with the mean CCC for all test conditions, including horizontal or vertical autorotations with open eyes or closed eyes (P

Chien-Hsi Chang,1 Zhi-Xian Lai,1 Hsiu-Li Lin,2 Che-Chuan Yang,3 Hsin-Hsien Chen,3,4 Shieh-Yueh Yang,5 Herng-Er Horng,3 Chin-Yih Hong,6 Hong-Chang Yang,4 Hsiu-Chen Lin1,71Department of Laboratory Medicine, Taipei Medical University Hospital, 2Department of Neurology, General Cathay Hospital, Sijhih Branch, 3Institute of Electro-optical Science and Technology, National Taiwan Normal University, 4Department of Physics, National Taiwan University, 5MagQu Co, Ltd, Sindian District, New Taipei City, 6Department of Mechanical Engineering, Nan-Kai University of Technology, Nan-tau County, 7Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, TaiwanBackground: Magnetic nanoparticles biofunctionalized with antibodies are able to recognize and bind to the corresponding antigens. In this work, anti-C-reactive protein (CRP) antibody was covalently conjugated onto the surface of magnetic nanoparticles to label CRP specifically in serum.Methods: The level of serum CRP was detected by immunomagnetic reduction (IMR) assay, which identifies the changes in the magnetic signal representing the level of interaction between antibody-conjugated magnetic nanoparticles and CRP proteins. To investigate the feasibility of IMR for clinical application, pure CRP solutions and 40 human serum samples were tested for IMR detection of CRP to characterize sensitivity, specificity, and interference.Results: In comparison with the immunoturbidimetry assay, the results of the IMR assay indicated higher sensitivity and had a high correlation with those of the current immunoturbidimetry assay.Conclusion: We have developed a novel and promising way to assay CRP in human serum using immunomagnetic reduction in clinical diagnosis.Keywords: magnetic nanoparticles, immunomagnetic reduction, C-reactive protein

Temperature is a characteristic often correlated with environmental and health issues. This paper presents an organic thin film transistor (OTFT) based temperature sensor having a detection range of 30–45 °C, which, therefore, encompasses the human body temperature. The OTFT sensor featured thermosensitive poly(N-isopropylacrylamide) (PNIPAM) and pentacene as the gate dielectric and semiconductor, respectively. The PNIPAM film possessed a dielectric constant of 4.2 with very low leakage current density. The OTFT exhibited high electrical performance, with a hole mobility (μ) of 0.90 ± 0.04 cm2 V−1 s−1, a threshold voltage (Vth) of −15.4 ± 1.16 V, and an on/off ratio of 104. Significant changes in the drain current and the values of Vth and μ occurred when the temperature of the device was varied within the range 30–45 °C at an interval of 0.5 °C. The operating principle for this temperature sensor was based on the structural transformation of the PNIPAM dielectric and the enhanced charge transport of the pentacene semiconductor upon varying the temperature. Flexible OTFTs fabricated on polyethylene terephthalate substrate displayed hole mobilities as high as 0.39 ± 0.01 cm2 V−1 s−1, values of Vth of −18.6 ± 0.45, and on/off ratios of 102, and were workable for over 100 bending cycles.

Tzu-Hao Huang,1 Chih-Jung Chen,2– 4 Hsin-Chia Angela Lin,1 Chun-Han Chen,1,&ast; Jia-You Fang5– 7,&ast; 1Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; 5Graduate Institute of Natural Products, Chang Gung University, Kweishan, Taoyuan, Taiwan; 6Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, and Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan; 7Department of Anesthesiology, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chun-Han Chen, Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, 6, W. Sec., Jiapu Road, Puzih City, Chiayi County, 61363, Taiwan, Tel +886-5-3621000 ext. 3821, Fax +886-5-3623002, Email chen5746@cgmh.org.tw Jia-You Fang, Graduate Institute of Natural Products, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-2118800, Fax +886-3-2118236, Email fajy@mail.cgu.edu.twPurpose: Morbid obesity and its related metabolic syndrome are an important health issue. Recently, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have accounted for the most popular bariatric surgeries. Valsartan (VST) is a common hypertension drug, and nano-carriers can increase its solubility and bioavailability. This study aims to explore the nano-VST formula in bariatric surgery subjects.Methods: High-fat fed animals were used as obese models. Operations were performed according to a standardized protocol. The drug was administrated by gavage, and blood samples were taken by serial tail vein sampling. Caco-2 cells were used for examining cell viability and drug uptake. A self-nano-emusifying drug delivery system (SNEDDS) formula was composed of sefsol-218, RH-40 and propylene glycol by a specified ratio, while high-performance liquid chromatography (HPLC) was used for determining drug concentrations.Results: Post-operatively, subjects that underwent RYGB lost more body weight compared to the SG group. The SNEDDS did not exhibit cytotoxicity after adequate dilution, and the cytotoxicity was not related to VST dose. A better cellular uptake of SNEDDS was observed in vitro. The SNEDDS formula achieved a diameter of 84 nm in distilled water and 140 nm in simulated gastric fluid. In obese animals, the maximum serum concentration (Cmax) of VST was increased 1.68-folds by SNEDDS. In RYGB with SUS, the Cmax was reduced to less than 50% of the obese group. SNEDDS increased the Cmax to 3.5 folds higher than SUS and resulted in 3.28-folds higher AUC0-24 in the RYGB group. Fluorescence imaging also confirmed a stronger signal of SNEDDS in the gastrointestinal mucosa. SNEDDS accumulated a higher drug concentration than suspension alone in the liver of the obese group.Conclusion: SNEDDS could reverse the VST malabsorption in RYGB. Further studies are mandatory to clarify post-SG change of drug absorption.Keywords: gastric bypass, sleeve gastrectomy, valsartan, nano-drug delivery system